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PRINTED: 05/04/2012 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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The printed 0504 department is a form used for reporting financial information.
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The purpose is to gather financial information for tax or regulatory purposes.
Information such as income, expenses, and deductions must be reported.
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